608 THE STREPTOCOCCI OF MAN 



Agglutination. Aronson's serum has considerable agglutinating pro- 

 perties for most streptococci. Some cultures are agglutinated in a dilution 

 of 1 in 20,000. 



[More recently Aronson, in immunizing horses, has used in addition to his 

 passage organism a number of other streptococci which have not been passed 

 through animals.] 



Moser's serum. With a view to the preparation of an antiscarlatinal serum Moser 

 used a number of streptococci isolated from cases of scarlet fever. He immunized 

 horses by repeatedly inoculating them with living cultures obtained by sowing broth 

 with blood from persons suffering from scarlet fever. No attempt was made to increase 

 the virulence of the organism by passage before using it for immunization. 



Moser's serum agglutinated .streptococci isolated from cases of scarlet i'ever. In the 

 laboratory it has some action, though feeble and inconstant, on streptococci which have 

 been passed through mice (Sommerfeld). 



In the treatment of scarlet fever opinions differ as to its value. According to some 

 observers it has a very beneficial action on the streptococcal infections of the disease 

 (Moser; Paltauf: Pospischill). Others unfortunately have failed to secure these beneficial 

 results (Moltchanoff, Baginski, Czerny) and as a therapeutic agent it is now practically 

 discarded. There is "nothing, from the biological point of view, to justify the 

 specificity of such a serum" (Besredka) and it has already been said above that in 

 scarlet feVer the streptococcus is merely a secondary, associated, infection. 



[Andrewes and Herder's serum. Seeing that in their experience the 

 Streptococcus pyogenes as denned by them (vide ante) is the commonest variety 

 in human streptococcal lesions, Andrewes and Horder prepare a specific 

 monovalent antipyogenes serum by using for the inoculation of horses strains 

 of their Streptococcus pyogenes. This serum seems to give much more satis- 

 factory results than any other antistreptococcal serum of which they have 

 had experience (Andrewes). 



[The most beneficial results are obtained in practice by using the serum in 

 conjunction with autogenous vaccines as adjuvants to the ordinary surgical 

 procedures. Thus in puerperal cases in which the serum has been more 

 extensively used than in any other class of streptococcal infection if the 

 temperature should rise above normal, a dose (50 c.c.) of the serum is admini- 

 stered there and then and a swab taken from the interior of the uterus. The 

 uterus is then douched. Twenty-four hours later a small dose (5 to 10 

 millions) of a vaccine prepared from the organism, usually S. pyogenes, grown 

 from the swab is given, followed later by other doses of the vaccine. Cases 

 treated thus at the first sign of infection almost invariably do well and do 

 not pass on to septicaemia (Andrewes). The secret of success lies in com- 

 mencing the treatment during the earliest stages of infection and before 

 the organism has passed beyond the uterine cavity. 



[A like procedure has been followed in other forms of streptococcal infec- 

 tions appendicitis, cellulitis, arthritis, etc. with distinctly encouraging 

 results (Girling Ball). 



[In streptococcal infections caused by varieties of streptococci other than 

 S. pyogenes similar treatment should be adopted and in infective endo- 

 carditis the use of a specifically immunized serum combined with an auto- 

 genous vaccine offers the best hope of recovery (Horder). It seems quite 

 likely as suggested by Horder that the combination of a specifically immunized 

 serum and an autogenous vaccine acts in a similar way to the " sensitized 

 vaccines" of Besredka.] 



B. Polyvalent serums. 



Convinced of the multiplicity of streptococci and noting the failure of 

 Marmorek's serum in clinical practice, various authors (Denys, Van de Velde, 

 Tavel) have prepared, by inoculating animals with emulsions of different 



